What lies beneath? Schema Therapy (Lifetraps Therapy)
Schema-focused, or Schema Therapy (ST), popularly referred to as Life-Traps Therapy, is an integrative psychological approach specifically for patients who are particularly resistant to treatment with Cognitive Behavioural Therapy (CBT).
It is also used as a treatment for managing certain personality disorders, including Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder.
The therapy is, effectively, an extension of Cognitive Therapy and was developed in the mid- to late-1980s, notably by Dr. Jeffrey Young.
ST is designed to work with long-standing, lifelong problems; problems which were once the sole 'domain' of Psychoanalysis and Psychodynamic psychotherapy.
But it brings to the table the more directive and structured format of CBT.
While Young did not necessarily set out to integrate the benefits of the two approaches he, nevertheless, was very much inclined to find a way to have the cognitive approach go deeper, addressing as he did some of the popular criticisms of CBT, such as its alleged superficiality.
There's something of an ironic twist here: Young's mentor and teacher, Aaron Beck, came to the cognitive approach because, as he freely admits in a video elsewhere on this website, to some extent, he had failed to make Freudian psychoanalysis work at a deep enough level when working with patients suffering from depression.
Young, on the other hand, had found that CBT worked perfectly well with patients who were depressed, but if there were any co-morbid issues, making the depression more complex, particularly if the issues were life-long, he found CBT to be less effective.
While Beck's answer was to 'abandon' the psychoanalytic approach altogether, in favour of developing CBT, Young's answer was to marry together the practical and active CBT from Beck, with certain aspects of Gestalt therapy and of psychodynamic psychotherapy, with the resulting synthesis of Schema Therapy known today.
The essence of Young's approach, his starting point, is that he believes it can be extremely helpful in treating psychological problems to look at where the problems originated — typically in early childhood — to help understand why the pattern reoccurs time and again.
Gestalt therapy is well-known for its use of imagery (among other emotion-focused techniques): a patient might, for example, close their eyes and picture themselves as a child, together with their parent or parents, where some or other upsetting memory is brought up, in order for the patient to truly get in touch with their anger, or inadequacy, or shame, or guilt, or other some feeling. And Schema Therapy will make use of this "limited reparenting" technique to a greater or lesser extent.
However, Schema Therapy is not eclectic in the sense that it 'borrows' a little bit of psychoanalysis here and, if that's unsuccessful, switch to Gestalt Therapy later, or move over to CBT if the Gestalt isn't working. On the contrary, Schema Therapy seeks to develop an inetgrated and unified conceptual model.
It draws from different therapy currents, but in a systemised, coherent, blended and structured framework.
Young's research centres around the identification of eighteen common schemas (from the Greek word meaning 'form'), or life themes, life patterns, or life traps.
It's best to think of schemas as clusters of preconceived ideas, prejudices and reflexes that form the core of our behavioural instincts. They are grouped into five broad areas that reflect areas of our upbringing: rejection; overprotection; overindulgence; other directedness (i.e. guided by others' standards, not one's own); and inhibition.
The basic idea is that if exposed to the wrong kind of nurture in our early years, we develop odd reflexes and coping mechanisms. These are very resistant to change, and don't really respond to logic.
The list of 18 self-destructive life traps (eleven of which were detailed in his popular book from 1993, Reinventing Your Life. The Breakthrough Program to End Negative Behavior…and Feel Great Again), from abandonment to defectiveness, to mistrust and abuse to unrelenting standards, have been designed to capture the main themes that people have that start in early life.
One of the reasons for its popularity is that Schema Therapy deliberately sets out not to appear to blame the victim for his or her own psychological disorders and problems, something that the drier diagnostic tools appear to do. In an audio file that can be downloaded elsewhere on this website, Young makes clear:
"… a client feels much better being told that they have an abandonment issue [sensitive throughout their life to feeling as though significant people in their life will leave them, for whatever reason], than they do being labelled 'hysteric' or 'borderline personality disorder.' It better fits with what people actually feel and it doesn't have that sort of pejorative label that these other diagnoses have"
One of the other big advantages of the Schema approach is that the life traps are readily recognisable and accessible — easy to grasp. Most people, when they read the list, can usually see four or five life traps that easily apply to them.
Schema Therapy is particularly useful to help psychological problems around relationships.
Over the years, Young has developed the Schema model for use in Couples Therapy. Here the therapy looks at which life traps each partner has, showing how and where each partner's respective schema might clash with and trigger one another's. As a consequence, therapy can address problems of constant conflict extremely effectively.
Schema Therapy is often used in combination with Mindfulness Practice, the two are extremely compatible.
See the treatment strategy, Life-traps and Schema Focused Therapy